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Session highlights

National Conclave
Nourishing India’s
Tribal Children
Voices of frontliners, promising
practices and policy implications

Synthesis of deliberations
and recommendations

15-16 January 2015


Mayfair Convention,
Bhubaneswar, Odisha, India

Synthesis of deliberations and recommendations a


National Conclave
Nourishing India’s
Tribal Children
Voices of frontliners, promising
practices and policy implications

Synthesis of deliberations
and recommendations

15-16 January 2015


Mayfair Convention,
Bhubaneswar, Odisha, India
©UNICEF India/Dhiraj Singh
CONTENTS
Background 1

Objectives 2

Delegates 3

Conclave format 4

Session highlights 7
Plenary 1: Inaugural ceremony 7
Plenary 2: Context setting 9
Parallel sessions: Challenges, promising practices and recommendations 14

Parallel session 1: Improving household food and livelihood security 15

Parallel session 2: Improving Integrated Child Development Services in


tribal areas 18

Parallel session 3: Improving tribal health outreach and referral services 21

Parallel session 4: Improving drinking water and sanitation services/


commodities in tribal areas 24

Parallel session 5: Tribal budgets, governance and coordination for nutrition 26

Parallel session 6: Role of academic institutes and NGOs in improving nutrition


services in tribal areas 29
Special community conclave: Voices of frontliners 32
Plenary 3: Way forward 34

Post-conclave ripples 35

Annex: Conclave agenda 36


©UNICEF India/Sandesh Bandare

   National Conclave: Nourishing India’s Tribal Children


Background

Stunting in children is a measure of chronic nourished. These include (i) Ministry of


undernutrition, with irreversible, profound Rural Development; (ii) Ministry of Public
and lifelong consequences. A stunted Distribution and Civil Supplies; (iii) Ministry
child is significantly less tall than would of Health and Family Welfare (MoHFW); (iv)
be expected for his or her age. Stunting Ministry of Women and Child Development
contributes to one third of under-five (MWCD); (v) Ministry of Drinking Water and
deaths globally, and adversely affects a Sanitation; and (vi) Ministry of Tribal Affairs
child’s health, cognitive capacity, school (MoTA).
performance and productivity in adulthood.
The Ministry of Tribal Affairs, being the
According to the National Family Healthy nodal ministry for welfare, development
Survey (NFHS) 2005-2006, 48 per cent and protection of tribal children, has the
of Indian children under five are stunted. mandate to convene, coordinate and
The prevalence of stunting is highest (54 synergize efforts of line ministries to reduce
per cent) among children of India’s tribal undernutrition in tribal children. However,
peoples. In terms of numbers, 6.2 million its role for ‘nutrition’ remains untapped.
out of 11.5 million tribal children aged
under five in India are stunted. Nine tribal In order to accelerate synergistic multi-
dominated states of central India collectively sector actions to reduce stunting in tribal
house 4.7 million of these stunted children: children of central India, a two-day national
Andhra Pradesh, Chhattisgarh, Gujarat, conclave to draw attention to stunting
Jharkhand, Madhya Pradesh, Maharashtra, among tribal children across the nine states
Odisha, Rajasthan and Telengana. of central India was held on 15-16 January,
2015, in Bhubaneswar, Odisha, India.
Stunting in tribal children is severe and
influenced by multiple interrelated factors. The conclave was jointly organized by
These include household poverty and food the Ministry of Tribal Affairs and UNICEF,
insecurity, maternal nutrition before and during in collaboration with the Ministries of
pregnancy, poor complementary feeding Women and Child Development, and
practices in the first two years of life, and poor Health and Family Welfare. It was
access to water, health and sanitation services. hosted by Odisha’s Scheduled Tribes
and Scheduled Castes Development
At least six ministries have a role to Department, Research Training Institute
play to ensure tribal children are well and UNICEF Odisha.

Synthesis of deliberations and recommendations 1


Objectives
©UNICEF India/Kesab Chandra

The national conclave on tribal nutrition had two main objectives:

1. Identify challenges and promising


practices [‘what works and how’] for
improving food, livelihood, Integrated
2. Deliberate how government
departments in these states can
coordinate, contribute and commit
Child Development Services (ICDS), to reducing stunting in India’s tribal
health and sanitation services for children by involving frontliners,
tribal children in the nine states of practitioners and various government
central India. departments in the nine states.

2 National Conclave: Nourishing India’s Tribal Children


Delegates

©UNICEF India/Kesab Chandra


The conclave brought together 297 Water and Sanitation, and Rural
delegates from state and district Scheduled Development; and the Prime Minister’s
Tribes and Scheduled Castes Departments; Office (PMO).
Tribal Research Institutes; Commissioners
of State Departments of Women and Child Representatives from non-governmental
Development, Health and Family Welfare, organizations (NGOs), academia, print
and Drinking Water and Sanitation; national and electronic media, and UNICEF offices
representation from five ministries – Tribal at national and state level were also in
Affairs, Health and Family Welfare, Women attendance.
and Child Development, Drinking

Synthesis of deliberations and recommendations 3


Conclave format
©UNICEF India/Kesab Chandra

The first two plenary sessions set the The six thematic sessions covered all
context and provided a platform for underlying and basic determinants of
national government officials and key undernutrition in tribal children:
stakeholders to affirm their commitment l Improving household food and livelihood
to improve nutrition of tribal children. This security
was followed by six parallel sessions, l Improving Integrated Child Development
which focused on sharing state-level Services in tribal areas
promising practices [‘what works and how’] l Improving tribal health outreach and
through presentations by practitioners referral services
and identifying the challenges and l Improving drinking water and sanitation
recommendations through group work. services/commodities in tribal areas

4 National Conclave: Nourishing India’s Tribal Children


l Tribal budgets, governance and work. Furthermore, stalls of uncultivated
coordination for nutrition forest foods were showcased by nine tribal
l Role of academic institutes and NGOs in community federations/community-based
improving nutrition services in tribal areas organizations associated with five NGOs2,
which was a special highlight of the
Each parallel session was led by a two-day event.
government official and moderated by a
reputed media personality. A synthesis of recommendations emerging
from the parallel sessions were presented
To ensure that voices of frontliners were during a concluding plenary session, with
adequately captured, an additional special reflections by senior government officials
parallel session was organized with tribal from the Prime Minister’s Office, Ministry
community members. This session was of Rural Development and Ministry of Tribal
moderated by Ministry of Tribal Affairs Affairs on the way forward.
representatives. Similarly, a special session
was held for media representatives for their The UNICEF 2014 report3 – Nourishing India’s
interaction with experts. See Annex for the Tribal Children – which presented an analysis
conclave agenda. of existing data on the determinants of
stunting among tribal children, documentation
Market stalls of select NGOs1 working in of 12 promising practices and affirmative
tribal areas displayed descriptions of their actions as well as a supporting pack of 11
ongoing nutrition related development films were circulated to all participants.

1
Development Research Communication and Service Centre, Digital Green, Gramvikas, Living Farms, MS Swaminathan Research Foundation,
Reach India and Sewa Rural.
2
Abhiyakti Foundation, Development Research Communication and Service Centre, KIRDTI, Living Farms and SACAL.
3
UNICEF, Nourishing India’s Tribal Children: The nutrition situation of children of India’s scheduled tribes, 2014.

Synthesis of deliberations and recommendations 5


©UNICEF India/Kesab Chandra

6 National Conclave: Nourishing India’s Tribal Children


Session highlights

©UNICEF India/Kesab Chandra


Plenary 1
Inaugural ceremony

The inaugural session reiterated Surendra Kumar, Indian Administrative


commitment towards India’s tribal children, Service, Secretary, Scheduled Tribes
which began with lighting of the lamp and Scheduled Castes Development
by panel members. While delivering the Department, Government of Odisha,
welcoming note, Yumi Bae, UNICEF Chief highlighted that this conclave was the
of Office, Odisha, invited delegates to culmination of a year-long dialogue with
use the conclave for mutual learning and UNICEF to ensure that the best evidence
understanding on how different sectors and practitioners across the nine states and
could pool resources, time and expertise to six line departments could come together
nourish tribal children. to discuss the multiplicity of issues and

Synthesis of deliberations and recommendations 7


solutions to end undernutrition in traditional taboos. He apprised the delegates
tribal children. of the Citizens’ Alliance Against Malnutrition
– a bipartisan alliance of members of
Louis-Georges Arsenault, UNICEF India parliament, which has potential to lead and
Representative, emphasized the need to initiate change for nourishing tribal children.
focus on inter-ministerial coordination,
nutrition of tribal women during Sudam Marndi, Minister of State, Tribal
preconception, and to ensure food and Welfare, Odisha, stressed the need to
livelihood security linkage with nutrition contextualize channels of communication in
promotion. He also emphasized the order to effectively communicate with tribal
importance of listening to the voices of peoples, and to work with them as partners
frontliners, at which point a film produced by of change. He highlighted the importance of
UNICEF was shown. documenting promising practices to ensure
cross-fertilization of ideas.
The film captured recommendations from
frontline workers across five states on the Lal Bihari Himirika, Minister, Scheduled
actions needed to reduce undernutrition in Tribes and Scheduled Castes Development
tribal children. These included promoting Department, Odisha, and chief guest,
indigenous food forests, improving access inaugurated the event. He stated that a
to livelihood and universalization of public better nutritional outcome requires not only
funded crèches in tribal areas, strengthening food security but also adequate access to
quality and monitoring of anganwadi health, clean drinking water and other basic
centres (AWCs), and better enforcement of amenities. He highlighted a state initiative,
community forest rights. Mamata, which provides conditional cash
to pregnant women to promote access to
Baijayanta (Jay) Panda, Member of antenatal and postnatal care. He concluded
Parliament and member of Citizens’ Alliance by stating that national progress would
against Malnutrition, emphasized the remain incomplete without taking the needs
importance of addressing anaemia in the and aspirations of the tribal population into
mother, early and repeated pregnancy, early account as they contribute to the bulk of
child care and feeding practices, gender and undernourished Indian children.

8 National Conclave: Nourishing India’s Tribal Children


Session highlights

©UNICEF India/Kesab Chandra


Plenary 2
Context setting

During Plenary 2, panellists highlighted the Health and Family Welfare; Gulshan
severity of child stunting in tribal areas and Lal, Ministry of Women and Child
the perspectives of five different ministries Development; Urvashi Prasad, Ministry
on the ongoing efforts to improve nutrition of Drinking Water and Sanitation;
services in tribal areas. Presentations Nita Kejrewal, Ministry of Rural
were made by Saba Mebrahtu, Child Development; and S.B. Agnihotri,
Development and Nutrition Section, Cabinet Secretariat. Key messages
UNICEF India; Gopal Sadhwani, Ministry from this session are summarized in
of Tribal Affairs; Manoj Jhalani, Ministry of this section.

Synthesis of deliberations and recommendations 9


1. Focus on districts contributing to done at the block for developing context-
maximum burden and deliver proven specific strategic plans.
interventions at scale (iii) Select key priority departments to come
together in support of identified priority
Globally, 10 proven interventions, if delivered interventions, and provide results-based
at scale, can reduce undernutrition among incentives to achieve the specific targets,
children, including tribal children (see Figure). given that each of these interventions
are not necessarily handled by one
The following steps for a strategic approach sectoral ministry. Evidence exists in
were highlighted: Latin America (Brazil and Peru) and Asia
(i) Map the districts within the nine states (Bangladesh) showing that such a multi-
contributing to the highest burden of sectoral approach can yield impressive
stunted children in terms of numbers. results. Nepal has successfully brought
(ii) Identify the gaps in access to the together key line ministries to develop
10 interventions for each of these an evidence-informed and results-based
high burden districts, which could be multi-sector nutrition plan, and is in the
contributing to the high levels of stunting. process of implementing it in select high
Where data permit, this analysis to be burden areas.

Figure: Ten proven interventions to reduce undernutrition in children

Care for women before and during pregnancy


1. Prevent pregnancies – too early, too many and too soon.
2. Adequate micronutrients, food, care and support for women pre-
conceptually, during pregnancy and between pregnancies.

Infant and young child feeding practices


3. Initiation of breastfeeding within one hour of birth.
4. Exclusive breastfeeding during the first six months of life.
5. Timely introduction of complementary foods at six months of age.
6. Age-appropriate foods for children aged six months to two years.

Access to health, water and sanitation services/commodities


7. Immunization and bi-annual vitamin A supplementation with
deworming.
8. Appropriate feeding for children during and after illness.
9. Therapeutic feeding for children with severe acute malnutrition in
facility and community.
10. Improve access to safe drinking water and sanitation commodities.

10 National Conclave: Nourishing India’s Tribal Children


Session highlights

2. Vanbandhu Kalyan Yojana paves the fungal infections) and snake bites are
way to demonstrate multi-sectoral common among the tribal population.
change in tribal areas Chhattisgarh, Jharkhand, Madhya
Pradesh and Odisha are among the major
The Ministry of Tribal Affairs does not contributors of the high burden of malarial
have a vertical implementing cadre. It disease. Alcoholism and tobacco use are
depends on 28 sectoral ministries, and their also common, which can further aggravate
respective line departments in the states, the already poor health conditions of the
for the provision of basic civic and welfare tribal population.
services to tribal peoples according to their
state plan and tribal sub-plan (TSP). MoTA 4. Tribal and other marginalized areas
provides top-up grants to its state scheduled require more effort to reduce existing
tribe departments, under special central health inequities
assistance (SCA) and provisions under
Article 275 (1) of the Constitution, for special Tribal blocks, marginalized and hard-to-
projects to be undertaken in tribal sub-plan reach populations are prioritized in the
blocks. MoTA has very little control over the Reproductive, Maternal, Newborn, Child
implementation of the TSP. and Adolescent Health (RMNCH+A)6
framework, as well as in the vector and
On 28 October, 2014, MoTA launched the malaria control programme. The MoHFW
Vandbandhu Kalyan Yojana4 to improve has also constituted a national tribal health
infrastructure and human development task force. For the tribal dominated high
indices on a pilot basis in one block among burden districts, there is provision for
the lowest literacy blocks in the scheduled relaxed norms; mobile services; incentives
V states5 of the Indian Constitution. for infrastructure, human resources and
Towards this end, INR 1 million has been accredited social health activist (ASHA)
allocated to each block, which may be used recruitment; enhanced financial allocation;
to demonstrate multi-sectoral nutrition flexibility; and dedicated budget lines
programmes for tribal children. for tribal reproductive child health (RCH)
to tackle the specific constraints and
3. Tackle major infections such as bottlenecks being faced in these areas.
malaria and tuberculosis
There is renewed focus on strengthening
Child mortality and undernutrition indicators health sub-centres in tribal blocks as the
are well known to being high in tribal areas. ‘first port of call’ with increased human
A probable key contributing factor is the fact resource. Some state innovations include:
that tribal children are less likely to receive partnership with NGOs for service
immediate referral care. Health issues, such delivery in civil strife affected districts
as malaria, sickle cell anaemia, tuberculosis, (e.g., Chhattisgarh); birth waiting rooms,
various skin infections (e.g., scabies and provision of long lasting insecticide treated

4
 anbandhu Kalyan Yojana, implemented by MoTA, seeks to bring the tribal population at par with other social groups and include them in the
V
overall progress of the country.
5
These states are same as the nine states with the highest burden of stunting among tribal children discussed at this conclave.
6
RMNCH+A is a national programme that addresses the major causes of mortality among women and children as well as the delays in
accessing and utilizing health care and services.

Synthesis of deliberations and recommendations 11


nets and use of the geographic information 7. Vulnerability Reduction Fund
system (GIS) for planning and monitoring provides opportunity to layer
(Odisha); boat clinics (Assam); indigenous nutrition interventions in Aajeevika
transport (Gujarat, Himachal Pradesh);
bed grant scheme (Tamil Nadu); and a Aajeevika, the National Rural Livelihoods
tribal coordination cell in district hospitals Mission, presently works with 100 million
(Maharashtra). poor households organized into 7-9 million
self-help groups and their federations
5. ICDS restructuring could serve as at village and cluster level. It provides
a good platform to improve reach handholding support to enable them to
and coverage in tribal areas come out of abject poverty and strengthens
existing livelihoods. Aajeevika as an
There are 7,076 projects and 1.4 million entity is exploring various gender, anti-
AWCs approved under the ICDS. Out of human trafficking, sanitation and nutrition
these, 2,544 projects and 535,499 AWCs promotion interventions to layer in voluntary
are in rural/tribal areas of the nine states. organization (VO) mandates where VOs are
The ICDS projects in Attapady, Thane and mature (1-2 years work experience and have
Melghat have made strides in strengthening received and managed other grants such as
AWCs in tribal areas. Provisions for additional the Community Investment Fund).
anganwadi workers (AWWs), setting up
of crèches in 5 per cent of AWCs, AWC Such models within Ajeevika have been
extension counters, and services using a seen in some State Rural Livelihood
cluster approach are available under ICDS Missions such as the health risk fund and
restructuring in the 200 high burden districts, food security fund (Bihar), homestead
many of which are tribal dominated. kitchen gardens (Odisha), and hot cooked
meals and counselling for pregnant and
6. Promising practices exist for improving lactating women (‘one full meal’ scheme
access to water and sanitation in Andhra Pradesh and three paid meals in
Bihar and Andhra Pradesh). It is envisaged
There are valuable state experiences in that the Vulnerability Reduction Fund can be
improving access to water and sanitation in used for such layering of interventions.
tribal areas across some of the nine states.
Some of these include: training local youth 8. Do not let the middle order collapse:
on basic geo-hydrology and water resource right interventions and team effort
engineering to support development of needed
village water security plans (Gujarat); and
community group led and managed total The task of eliminating child undernutrition is
sanitation systems, wherein credit linkages like chasing a given target of runs in a cricket
with banks, monetary financial institutions match. The entire team has to contribute
(MFIs) and self-help groups (SHGs) were to achieve it. An important factor is healthy
made for toilet construction, and women self- mothers, best indicated by the proportion
help groups have set up systems of waste of adolescent girls with body mass index
management in rural areas (Tamil Nadu). In (BMI) above 18. Mother’s weight gain during
Chhattisgarh, possessing a household toilet pregnancy is the next important parameter
at home is included in the eligibility criteria for followed by proportion of low birth weight
contesting local elections. (LBW) babies. After this, the nutritional

12 National Conclave: Nourishing India’s Tribal Children


Session highlights

status of the child in the first six months status in the 0-6 month age group and no/
is important, as it is an indication of the low incident of LBW. Important factors to
prevalence of early breastfeeding initiation achieve this are (i) adequate weight gain
and exclusive breastfeeding. by the mother; (ii) timely antenatal care;
(iii) tetanus toxoid vaccine for the mother;
The trouble usually begins in the 7-36 and (iv) identification of mothers at risk. If
month age groups. Children in these age there is a low incidence of BMI below 18
groups – 7-12, 13-24 and 25-36 months – among adolescent girls and higher age at
usually show a rapid decline in nutritional first pregnancy, it is equivalent to winning
status. There is a mild recovery in the 37-72 the toss.
month age group, but it is not enough to
compensate for the decline seen between 9. Find the undernutrition-free districts
7-36 months. In addition, losses in brain
and physical development during this It is important to strike a balance between
early period of life are never recovered. projecting the states and districts
This pattern can best be described as the contributing to the highest burden of
‘collapse of the middle order’ in cricketing malnutrition in absolute numbers and
language. The batting performance of the prioritizing these for corrective strategic
team also depends on the conditions of the actions, and locating the leading districts
outfield – immunization coverage, extent of – those that are closest to becoming
open defecation and the like. To elaborate, undernutrition free. Incentives can be
therefore, while chasing a given target, the provided at the district level for good
performance in the ‘middle order’, i.e., 7-36 performance and for better results.
months, is the most important component.
10. Marry NFHS data on National Sample
Strategies for the 0-36 month age group Survey Office regional platforms
would consist of: (i) complete coverage
of essential nutrition services for children A solution needs to be found for various
aged 7-36 months; (ii) 90 per cent or above regional levels instead of the ‘one size fits
weighing efficiency; (iii) timely reporting all’ central planning. For this, it is urgently
of the nutritional status; (iv) preventive necessary to bring the NFHS, District
measures like deworming and immunization Level Household and Facility Survey
coupled with remedial treatment measures; (DLHS) and the National Sample Survey
(v) sanitation measures; and (vi) special Office (NSSO) data (and other similar
measures for specific groups. databases) on the 88 NSSO regional
platform for use in research and policy
This should be backed up by a better score decisions and strategic actions.
by the openers, i.e., better nutritional

Synthesis of deliberations and recommendations 13


©UNICEF India/Kesab Chandra

Parallel sessions
Challenges, promising practices
and recommendations

14 National Conclave: Nourishing India’s Tribal Children


Session highlights

Parallel session 1: Improving household food and livelihood security

Challenges course resulted in limited benefits with


trainees managing only to obtain low
The following challenges constraining paying jobs such as cleaning/sweeping
improvement of household food and in hotels.
livelihood security in tribal areas were
highlighted during the parallel session: 5. The average number of days of work of a
tribal person under the Mahatma Gandhi
1. Access to food is limited due to poor National Rural Employment Guarantee
market access and purchasing power. Act (MGNREGA)7 was 49 days during
Income security has been adversely 2013-2014. Children of working parents
affected by losses in productive are the worst affected as there are no
resources (rights to forest or agricultural crèches at MGNREGA sites.
lands coupled with low amounts or
utilization of compensation). Debts are 6. Indigenous seeds and methods, and
one of the main coping strategies to help mixed cropping are not used to make
cover expenditures, which are usually agriculture nutrition-sensitive; they
repaid to the village money lender in are neither promoted nor incentivized.
services or periodical bonded labour, The forest is not recognized as a food
resulting in a hand-to-mouth existence producing habitat. Planted trees are
for those affected. often not fruit/food producing.
Uncultivated yet nutritious tribal foods
2. Access to public distribution system are considered unfashionable by
(PDS) entitlements is constrained by poor communities themselves.
definition of ‘below poverty line’, coupled
with limited to negligible awareness on 7. Other challenges include: reliance
where and how to access ration cards and on rain-irrigated agriculture, which is
entitlements. PDS supply items also do increasingly unreliable or unpredictable
not include traditional foods consumed due to climate change; use of traditional
by tribal groups, who often do not eat the practices of production and technologies;
cereals provided through PDS. depleting natural resource base; distress
migration for basic survival and livelihood;
3. Poor banking penetration and banking and use of pesticides in agriculture,
literacy pose a challenge to the transfer adversely affecting the health of the
of conditional cash benefit to the mother and child in the womb.
tribal population; furthermore, banking
correspondents are few in these areas. Promising practices

4. Vocational training is often not suited to The following promising practices were
the needs/culture of tribal peoples. For presented and discussed during the
instance, a hotel management training parallel session:

7
MGNREGA is designed to provide a job guarantee of at least 100 days of unskilled work for adults in rural areas.

Synthesis of deliberations and recommendations 15


1. Nutrition promotion and early child their capacities in soil health improvement,
care linked to food security and stabilization of paddy yields and incorporation
livelihood support of nutritious crops in the overall cropping plan,
e.g., vegetables, millets and pulses, to ensure
Three models were presented and discussed food sufficiency for 9-12 months.
on this topic. The first model relates to the
‘one hot cooked meal scheme’ in Andhra 3. Online PDS portal to reach the most
Pradesh and Telengana, wherein pregnant vulnerable
and lactating women are provided one
cooked afternoon meal each day, at the Samagra, a social security programme
cost of INR 15 per meal. Raw materials are run by the Madhya Pradesh government,
purchased by village organizations under is supporting identification, verification,
Aajeevika with funds from the Department of updates and categorization of all individuals
Women and Child Development. Anganwadi within families by respective local bodies
workers serve the meal, administer iron folic and linking households to their respective
acid (IFA) tablets, monitor weight and provide Fair Price Shops (FPSs) electronically.
counselling while health workers conduct Authentic, accurate and monthly FPS shop-
health check-ups. wise allocations of food grain are generated
from the State PDS Portal. Instead
The second model involves crèches run by of inclusion criteria, exclusion criteria have
mothers’ groups in Chhattisgarh with funds been ensured to reach out to the most
provided through the Village Health and vulnerable and marginalized. The Madhya
Sanitation Committee, which are routed Pradesh government has provided an
through panchayats. It aims to support tribal additional co-financing of INR 6 billion.
women as most are engaged in productive
work outside home. 4. Using technologies to improve
livelihoods and quality of life for
The third model uses a participatory learning tribal communities
cycle to link agriculture-based livelihood
and nutrition through behaviour change BAIF Development Research Foundation
communication, promotion of indigenous has been designated a centre of
foods, mixed cropping pattern and methods, excellence by the Ministry of Tribal Affairs
and gender-equity focus implemented by since March 2008. Technologies produced
two NGOs, Living Farms and Ekjut. by BAIF include WADI, a farming system
approach combining agri-horti-forestry
2. Khariff, or monsoon crop, yield with required in-situ soil and water
enhanced by System of Rice conservation works, integration of crop
Intensification diversification practices, intensification,
skill-oriented training for good production
Pradan – an NGO working across seven systems and integration of animal
states in India – shared their agriculture and husbandry, and continuous on-field
nutrition development experience covering 12 support using just 0.4 hectares of land.
districts in Chhattisgarh. Their intervention,
which uses an innovative technique called These practices are coupled with
System of Rice Intensification, includes interweaving quality of life actions, e.g.,
enhancing productivity of land, water and women development through the SHG
agriculture through the organization of federation, drudgery reduction measures,
women-led self-help groups and building clean drinking water, and health, nutrition

16 National Conclave: Nourishing India’s Tribal Children


Session highlights

and sanitation actions. Another technology In addition, mature village organizations under
involves capacity building for mixed Aaajevika’s resource blocks may also be
cropping, and promotion of small plot provided a livelihood option to run a ‘one stop
vegetables, water resource management shop’ for services and entitlements. They
and forward marketing linkages. could be trained using participatory learning
methods to layer nutrition in discussions in
Recommendations their weekly self-help group meetings as done
by Ekjut. It would also be useful to mainstream
The group work discussions held after this nutrition into the curriculum of the National
parallel session generated the following Institute of Rural Development and State
recommendations, which have been classified Institutes of Rural Development so that allied
into immediate-, medium- and long-term sectors become nutrition-sensitive.
actions.
4. Promote and provide incentives
Ministry of Civil Supplies for System of Rice Intensification
(medium to long term)
1. Evaluate online portal in (immediate
to medium term) Promote and provide incentives for the
System of Rice Intensification, uncultivated
Evaluate Samagra online portal in Madhya nutrient-rich forest foods, and local manure
Pradesh for sharing and adapting in other under Rashtriya Krishi Vikas Yojana and Nutri-
states. rich Program.

2. Include nutrient-dense foods in PDS 5. Ensure universal access to unconditional


(medium to long term) maternity entitlements (long term)

States to consider including nutrient-dense Ensure universal access to unconditional


foods, double fortified salt, fortified cereals, maternity entitlements for tribal mothers.
fortified edible oils, nutritious and culturally The business correspondent, or local bank
appropriate forest foods in PDS. representative, model has worked best for
financial inclusion by linking women groups,
Ministry of Rural Development which would ensure livelihood opportunity in
their locality.
3. Strengthen links between livelihood
support and nutrition promotion Ministry of Environment, Forest and
(immediate to medium term) Climate Change

Strengthen links between livelihood support 6. Protect community forests and


and nutrition promotion and build capacity promote cultivation of food yielding
to do so through Aajeevika (National Rural trees (medium to long term)
Livelihood Mission). Practices such as the
one full meal scheme, which should include Protect community forests by setting minimum
women of reproductive age, and WADI may proportion of land to remain as forestland for
be replicated. Such practices should include protection of indigenous livelihood as well
covering the service cost to the voluntary as the environment; and promote cultivation
organization so that nutrition promotion is and planting of trees that yield food or have
also a business enterprise. traditional medicinal values.

Synthesis of deliberations and recommendations 17


Parallel session 2: Improving Integrated Child Development Services in
tribal areas

Challenges Rehabilitation Centres (NRCs), or for


providing crèches with safe water supply
The following challenges constraining and toilets in remote tribal areas.
improvement of ICDS services in tribal areas
were highlighted during the parallel session: 5. Planning is still done population-wise
while hamlet-based population norms
1. Household care practices, especially are needed in tribal areas. ICDS data
during the vulnerable periods of coverage, allocations and expenditures
preconception, pregnancy and infants in for tribal pockets are still not available
the 6-36 months period, have remained and if so, are often unreliable. There is no
suboptimal. There is also suboptimal/ separate chapter for tribal ICDS under the
negligible use of take-home rations by ICDS Project Implementation Plan (PIP)
pregnant women and children provided and/or National Nutrition Mission. Many
under the ICDS supplementary nutrition faith-based and civil society organizations
programme. Health education and kitchen exist, but they do not work together to
gardens only are having a limited impact. deliver outreach ICDS services in tribal
areas affected by civil strife. Often,
2. Children aged under 36 months need procedures to engage with such partners
to be transported to the AWCs; they are tedious, political and non-transparent.
require frequent feeding with nutrient-
dense foods, and to be cleaned before Promising practices
meals and after using the toilet. They
need a ‘safe’ place to learn and play, with The following promising practices were
attention to age-appropriate learning presented and discussed during the parallel
needs. It is exhausting for the AWW, session:
who manages more children than the
optimum 1:10 worker:child ratio. With 1. Decentralized ICDS supplementary
more tribal mothers having to go out to nutrition programme led by women’s
work to earn a living, older siblings often groups
are forced to drop out of school to take
care of younger children. In Odisha, self-help groups provide hot
cooked meals and a morning snack
3. There are poor monitoring visits in tribal to children at the anganwadi centre.
pockets. There are tribal villages where Mechanisms have been put in place
no government officer has ever visited an for procuring grains and food from the
AWC, even in areas not affected by civil Food Corporation of India, selecting self-
strife. There is also an issue of non-tribal help groups, ensuring quality checks
workers looking down on tribal workers. and accounting, which is jointly done
with support of the AWW and elected
4. Most TSP budget items are focused on ward member. Menus are also locally
infrastructure and even then it remains contextualized. However, adherence to food
untapped for improving the infrastructure safety guidelines remain a challenge. The
of AWCs, or for establishing Nutrition model still needs to be evaluated for impact

18 National Conclave: Nourishing India’s Tribal Children


Session highlights

and whether livelihood generation and Presently, the Andhra Pradesh government
nutrition have been ably linked. has adapted this model and started a free ‘one
full meal’ scheme, a free noon meal provided
2. Trained paid workers in hamlet-based through a partnership between Aaajevika
crèches in tribal areas and the Department of Social Welfare, which
covers the service cost to self-help groups.
In Chhattisgarh, NGO Jan Swasthya
Sahyog (JSS) has demonstrated the Recommendations
feasibility, continuity and effectiveness of
hamlet-based crèches for children aged The group work discussions held under this
6-36 months for the last seven years in parallel session generated the following
forest fringe areas and forest villages of recommendations, which have been
rural Bilaspur. JSS has also developed the classified into immediate-, medium-,
operational requirements, costing, training and long-term actions.
materials and stationery needs, and a
troubleshooting guide for running such a 1. Set up Nutrition Rehabilitation
programme at scale. In addition to JSS, a Centres close to tribal communities
consortium (Action Against Malnutrition (immediate term)
and mobile crèches) is working on a similar
approach in Bihar, Jharkhand, Madhya Set up NRCs close to tribal communities
Pradesh and Maharashtra. in partnership with NGOs working in
tribal areas. Children with severe acute
3. Self-help groups run nutrition malnutrition (SAM) and with medical
counselling and feeding centres complications have specific medical
treatment needs to enhance their survival,
Mainstreaming feeding and nutrition and cannot be provided only supplementary
promotion through women self-help food through the Sneha Shivirs scheme, a
federations engaged in thrift and credit, and community based approach for prevention
livelihood initiatives has been carried out and management of moderate and severe
since 2007 across 4,200 villages of the state malnutrition. Underweight and severe acute
of Andhra Pradesh (before bifurcation). These malnutrition are different problems and need
federations provide pregnant and lactating to be acted upon differently.
women two hot cooked meals a day in their
community-managed nutrition cum day care 2. Set up special scheme for
centres set up for every 1,000 persons. preconception women and at-risk
pregnant women (immediate to
Each centre receives a one-time grant of medium term)
INR300,000 (US$5,000) and a recurring
annual grant as partial cost for the meals. Low pre-pregnancy weight and lack of
About one third of the cost of the meal is weight gain monitoring in pregnancy are
paid for by the women (INR10 (US$0.16) of important drivers of intrauterine growth
INR35 per person per day). To ensure they retardation. Hence, the package for
can pay this amount, they are encouraged preconception women should be expanded
to join the network of self-help groups and beyond Nutrition and Health Education.
undertake safe livelihood activities, which
enable them to earn about INR800-1,000 It is crucial to conduct periodic nutrition
per month (US$13-16). assessments of newly wed and pregnant

Synthesis of deliberations and recommendations 19


women during nutrition and health outreach 6-36 months should be universalized rather
sessions, followed by instituting corrective than putting a ceiling of using only 5 per
measures for those women identified as cent of AWCs as crèches and only one
‘at risk’ (along the lines of Sneha Shivirs for additional link AWW who can potentially be
children). These measures could include a crèche worker. The following requirements
enrolling undernourished women for special should be ensured:
feeding, behaviour promotion and family l Community driven rather than thrust

planning sessions. Emphasize information upon externally.


on various schemes and entitlements and l Open 8 hours a day, 26 days a month,

delaying age at marriage in these sessions. timings according to local work schedule.
l Run by adequately trained crèche

3. Take into account tribal workers from the same hamlet (need not
considerations within ICDS (medium be literate).
to long term) l Crèche worker:child ratio 1:10.

l Caretakers should be paid a regular

Hamlet-based planning and provision of wage, not on voluntary basis.


cluster or AWC extension counters should l At least three large feeds, a minimum of

be considered in tribal areas. ICDS food 75 per cent calories (at least 750 calories
items for tribal areas should include tribal out of 1,000) and all protein needs of the
uncultivated forest foods. child in this age group be met by these
three feeds; highly desirable to have
There should be separate review of tribal some animal proteins such as from milk
ICDS with a separate tribal nutrition or eggs.
coordination cell at national and state l Iron supplements daily and three monthly

levels to monitor implementation progress albendazole (deworming).


of tribal related schemes, at least within l Early child education.

the departments of Women and Child l Safe water and mosquito proof interiors.

Developmen and Health to begin with. l Growth and illness monitoring.

As in RCH, a separate PIP for tribal ICDS/


mission should be considered. Learning Inter-sectoral financial budget pooling
from promising practices is important, e.g., is possible among the departments of
projects in Attapady, Thane and Melghat. Women and Child Development (wages,
food, monitoring), Rural Development
4. Universalize public funded crèches (MGNREGA, space, toilets), Health
through trained paid workers in tribal (ASHA, drug supplies, bed nets) and the
areas (medium to long term) panchayat raj (community monitoring and
infrastructure support).
In addition to home visits by frontline
workers, crèches for tribal children aged

20 National Conclave: Nourishing India’s Tribal Children


Session highlights

Parallel session 3: Improving tribal health outreach and referral services

Challenges transportation, board and lodging, and


promotions/dual degree incentives).
The following challenges constraining
improvement of nutrition outreach and 5. TSP funds remain untapped for
referral services in tribal areas were establishing Nutrition Rehabilitation
highlighted during the parallel session: Centres in remote tribal areas.

1. Access to government health outreach 6. Tuberculous, malaria and sickle cell


and referral services is constrained by anaemia are major health problems and
geographical, linguistic, cultural and need deserved attention.
social barriers, as well as opportunity
cost (loss of wages, cost of travel time 7. Tobacco and alcoholism are major
to the facility and medicines). This is also problems. Habitual drinkers spend all
one of the core reasons for reliance on their earnings and cash benefits received
traditional medicine and spiritual healers. from government schemes on alcohol.

2. Health outreach communication in the 8. There is no integrated tribal health


local state official language cannot be dashboard monitoring system, which
understood by tribal peoples, given that combines vector borne diseases
each tribe has a language of its own and and health and nutrition indicators,
also because illiteracy is quite high. even though the NFHS, DLHS, Rural
Health Statistics and National Nutrition
3. Shortage of skilled human resource, high Monitoring Bureau provide tribal health
staff turnover and absenteeism are major care data. The specific provisions
problems in tribal areas, particularly in RMNCH+A can offer to tribal peoples
areas of conflict. While tribal peoples are should be highlighted and publicized.
preferred, it is difficult to find those who In addition, while the Indian Council of
match the qualification criteria. Postings Medical Research (ICMR) Jabalpur issues
in tribal areas are perceived, generally, as a six-monthly bulletin, the Tribal RCH PIP
‘punishment postings’ that are assigned chapter remains the most neglected.
to non-performers. Community health
services managed by nurses remain Promising practices
untapped.
The following promising practices were
4. Few professionals would like to work presented and discussed during the parallel
in these areas due to poor integrated session:
housing facilities, lack of recreational
facilities, poor roads and power supply, 1. Community clinics managed by
electricity problems, centralized human nurses, complemented by doctor
resource policies that often do not supervision and outreach activities
specify the duration of tribal postings,
and insufficient hardship allowances Such a model of a judicious mix of
for serving in difficult terrains (such as professionals skills (doctor, nurse and social

Synthesis of deliberations and recommendations 21


work team) and activities (clinic, community MoTA) for setting up NRCs in block
mobilization, home counselling and crèches hospitals run by them in Microeconomic
for nutrition support) has been demonstrated Social Organization zones (Jharkhand);
in difficult and dispersed tribal catchment young professionals attracted to support
areas of Udaipur, Rajasthan, by NGO basic the state level Development Commissioner
health services. The learning suggests that in tribal districts and work on special
community clinics led by nurses, nutrition projects (Gujarat’s Chief Minister’s
security activities and ambulances capable Fellowship Programme); tribal coordination
of going the last mile can work best in cell in district hospitals in tribal districts
partnership with NGOs under a public-private (Maharashtra); and focus on upgrading
partnership (PPP) model. tribal district hospital infrastructure,
context-specific bed linen and cash
2. A good school of nursing could be key transfers to access primary health care
facilities (Maharashtra).
This has been demonstrated by the
Christian Hospital, Bissamcuttack, Odisha, Recommendations
where a school of nursing is attached to the
hospital. The uniqueness of this school is The group work discussions held under this
that professionals from Odisha are trained parallel session generated the following
in nursing for the local population. This is recommendations, which have been
complemented by the Mitra Project in 53 classified into immediate-, medium-,
predominantly tribal villages, where primary and long-term actions.
outreach activities are conducted, including
malaria screening and management at 1. Provide incentives to NGOs
community level and a residential tribal running hospitals to establish
school, led and governed by the community. Nutrition Rehabilitation Centres
(immediate term)
3. Low cost health care technology and
improving logistics of public health The Ministry of Health and Family Welfare
should provide incentives to NGOs
Low cost health care technology and running hospitals with MoTA to establish
improving logistics of public health, such as NRCs for management of severely
rapidly taking malaria slides to laboratories acute malnourished tribal children with
from tribal areas, is important. Jan Swasthya complications, coupled with outreach
Sahyog in Chhattisgarh has adopted an prevention activities. These could
innovative approach in water purification eventually be linked to a community
systems and in keeping newborns warm by branch for treatment of SAM children
using sleeping bags (containing palm oil to without complications.
retain warmth).
2. Bundle nutrition-specific interventions
4. States show the way in promising (immediate to medium term)
practices
Nutrition-specific interventions, such as
Several states have promising practices vitamin A supplementation, and other
that could be adapted or relicated. These nutrition-sensitive actions (e.g., indoor
include partnership with NGOs (under residential spraying), should be bundled with

22 National Conclave: Nourishing India’s Tribal Children


Session highlights

the immunization days/weeks under the prevention and control with links to IFA
newly launched Indradanush, an universal programmes should be made available.
immunization programme, in tribal areas.
Advocate for Village Health and Nutrition 5. Establish tribal cell in Department
Days and Indradanush outreach days to be of Health and Family Welfare in
‘days of peace’ in conflict affected areas to tribal dominated states (medium to
ensure that health service providers are not long term)
restricted or questioned.
As in Andhra Pradesh, a tribal cell can
3. Expand nutrition basket to include play the following roles: (i) liaise with other
women during preconception and departments; (ii) monitor tribal budgeting,
at risk of pregnancy (immediate to expenditures in RMNCH+A, tribal RCH and
medium term) TSP, with specific guidelines on areas/
themes to include in the TSP; (iii) link with
Maternal undernutrition is an important ICMR on district-level tribal nutrition surveys
predictor of intrauterine growth, low once every three years; (iv) develop a tribal
birth weight, as well as maternal and info-system for disaggregated data using
neonatal mortality. Global literature now Health Management Information System
clearly establishes that fetal stunting is scorecards; (v) create a platform for sharing
largely because of overall nutrition and replication-worthy practices; and (vi) place
dietary insults in the first trimester, a time young professionals on special tribal projects
often when pregnant women do not reveal complemented by a health policy degree.
they are pregnant. Also, poor preconception
nutritional status and poor weight gain 6. Focus especially on tribal
during pregnancy are major independent Reproductive and Child Health
determinants of fetal stunting. programme in Ministry of Health
and Family Welfare (medium to
However, in India there is no mechanism long term)
in place to identify and provide a package
of nutrition interventions to women during MoHFW should take into account tribal
preconception or to identify pregnant considerations in its RCH programmes
women at nutrition risk and provide and consider the following actions:
them a special package of care. Nutrition (i) institutionalize weekly haats (markets) for
interventions that are a part of the antenatal outreach services in tribal areas; (ii) carry
service package also need strengthening out hamlet-based calculations; (iii) provide
both in terms of inclusion of ‘missing’ second ANM/community nurse at health
interventions, coverage and service provider sub-centre in tribal areas; (iv) provide central
capacity and monitoring. funds for improving quality services to
ashramshalas (residential schools) run by
4. Integrate malaria and sickle cell state governments; and (v) test training and
prevention with anaemia control engagement methods for traditional healers
programmes (medium term) and relaxing the Leave Travel Concession
norms for tribal areas.
For tribal peoples living in malaria endemic
areas, national guidelines on malaria

Synthesis of deliberations and recommendations 23


Parallel session 4: Improving drinking water and sanitation services/
commodities in tribal areas

Challenges 1. Water supply chains and water


harvesting improve access to water
The following challenges constraining
improvement of drinking water and ‘Unbundling’ of water supply chains,
sanitation services in tribal areas were collecting rainwater and water harvesting
highlighted during the parallel session: on hilly areas, along with installing mini
pipelines are being carried out in Gujarat.
1. Water crisis and lack of water
purification continues in tribal desert- 2. Local youth trained to support water
prone areas, and existing toilets are not security
often used, as many of them do not
have doors and/or water. In Gujarat, local youth are being trained on
basic geo-hydrology and water resource
2. Although toilets for girls in schools have engineering to support development of
been constructed, the water crisis makes village water security plans.
these toilets unusable.
3. Community managed sanitation
3. Many anganwadis do not have facilities linked to access to credit
for handwashing with soap, and often
have adult but not child toilets. Swasth In Tamil Nadu, community group led and
Bharat, a national health campaign, managed total sanitation systems, wherein
does not specifically target health centres credit linkages from banks, MFIs and SHGs
and AWCs. are made for toilet construction, and women
self-help groups have set up systems of
4. While community-based models are waste management in rural areas.
promoted, fund flow mechanisms and
newer technologies in these models 4. Local election eligibility criteria
need to be streamlined and percolated to include possessing household toilet
the community.
In Chhattisgarh, eligibility criteria for
5. There is still inadequate capacity contesting local elections includes
enhancement and support to panchayat possessing a household toilet at home.
raj institutions to implement and maintain
their own water and sanitation systems. 5. Government-NGO partnership
models improve water and sanitation
Promising practices infrastructure

The following promising practices were The Society for Participatory Research
presented and discussed during the parallel In Asia and NGOs Gramvikas and PRIA
session: help communities and gram panchayats

24 National Conclave: Nourishing India’s Tribal Children


Session highlights

work together in Chhattisgarh, Odisha and 2. Design and disseminate focused


Jharkhand to create and maintain water and communication messages targeting
sanitation structures and innovate global tribal areas (immediate to medium
positioning systems, as well as activate term)
District Planning Committees.
Enhance awareness of toilet use through
Recommendations focused communication messages, while
setting up mechanisms to ensure water is
The group work discussions held under this available for toilet maintenance and facility
parallel session generated the following for handwashing with soap.
recommendations, which have been
classified into immediate-, medium-, 3. Ensure water security (medium to
and long-term actions. long term)

1. Improve facility for handwashing Under the Vanbandhu Kalyan Yojana,


with soap and toilets for children devise and manage water security plans/
(immediate to medium term) systems, mini-pipe water supply schemes,
rooftop rain water harvesting and water
Ensure facilities for handwashing with soap regeneration plantation.
and children’s toilets in anganwadi centres
and Nutrition Rehabilitation Centres, 4. Motivate graduates to work in tribal
improve water and sanitation facilities areas (medium to long term).
in ashramshalas, and monitor water and
sanitation facilities in health centres for Open invitation and funding opportunities
tribal areas. should be provided to young rural
management and Indian Institutes of
Technology (IIT) graduates to work in tribal
areas for IT-based/low cost water and
sanitation solutions

Synthesis of deliberations and recommendations 25


Parallel session 5: Tribal budgets, governance and coordination
for nutrition

Challenges poor toilet facilities for girls and


absence of life skills and vocational
The following challenges constraining education in ashramshalas (residential
improvement of pro-tribal nutrition budgeting, schools).
plans and coordination were highlighted
during the parallel session: 2. The proportion of the special central
assistance allocation to TSP by the
1. Challenges in tribal sub-plans include: central government has been less than
(i) ‘food subsidy’ being treated as non- 5 per cent of the total TSP allocation for
plan expenditure, which has led to most states, coupled with huge paper
minuscule TSP allocation to PDS; work. Although meant for critical gap-
(ii) not all ministries and state plans filling, the critical gaps are not identified
apportion recommended funds and the SCA is transferred to the state
for TSPs; the only state to legalize scheduled tribe finance and development
apportioning funds to TSP is Andhra corporations for providing subsidy to the
Pradesh; bank-linked income generating schemes,
(iii) earmarking of funds is done without which are not linked with the sectoral
considering priorities, purpose or schemes being implemented by the state
track of its usage; governments under the TSP.
(iv) most TSP budget items focus on
infrastructure and miss out on soft 3. Evidence-based planning of programmes
components, such as basic outreach for tribal children is hindered by absence
services. On the other hand, the TSP of or dated disaggregated data by social
infrastructure budget remains untapped groups for schemes as well as the lack
for establishing or improving Primary of data analysis of social determinants
Health Care Centres, Nutrition of poor health and undernutrition in tribal
Rehabilitation Centres, crèches, and populations. There is limited publicly
AWCs with adequate water and available data necessary for reliably
sanitation facilities in remote tribal tracking programme budgetary allocation
areas; and and expenditure for tribal peoples.
(v) TSP is based on the assumption that
spending money will automatically 4. Institutions like the Integrated Tribal
lead to development of tribal peoples, Development Agency (ITDA) require
which underplays the role of ensuring technical staffing to enable the
effective delivery of essential services government to effectively coordinate
and enforcement of legislations to rather than just accepting tasks and
protect their social and economic achievement numbers given to them.
rights. In addition, there are problems Vandbandhu Kalyan Yojana provides a
of poor access to basic amenities, platform to test innovations to strengthen
absence of staff quarters for teachers, ITDA capacity.

26 National Conclave: Nourishing India’s Tribal Children


Session highlights

Promising practices (v) set up NRCs at block and primary


health centre level; and (vi) ensure doorstep
The following promising practices were direct delivery of PDS to village from block
presented and discussed during the parallel level godowns.
session:
3. Initiatives to improve nutrition focus
1. TSP legislation implemented to on tribal communities
improve accountability and planning
In Gujarat, some initiatives in tribal domains
Andhra Pradesh has improved accountability, include Doodh Sanjeevani Yojana, a
decentralization and inclusive planning in the programme providing milk in all primary
implementation of TSP. The state council schools; e-coupons in the PDS system;
for development of scheduled castes and partnership with cooperatives and NGOs
scheduled tribes is the nodal agency for TSP for delivery of services and presence of an
and has an administrative support unit and autonomous body, Development Support
institutional mechanism for monitoring and Agency of Gujarat, under Vanbandhu Kalyan
liaising with other departments. Importantly, Yojana, which has administrative and
there is a single line administration in institutional autonomy.
tribal areas – the ITDA is mandated with
autonomous bodies, complemented by Recommendations
Tribal Program Monitoring Units under the
National Rural Health Mission (NRHM), The group work discussions held under this
Sarva Shiksha Abhiyan, MGNREGA and parallel session generated the following
Rural Development. Improving infrastructure recommendations, which have been
and civic amenities in tribal areas has been classified into immediate-, medium-, and
the focus in many initiatives, as well as long-term actions.
teaching and using learning materials in
tribal dialects. Ministry of Tribal Affairs

2. Nutrition Mission a platform for 1. Generate disaggregated data for


convening inter-sectoral action for tribal peoples (immediate term)
nutrition of tribal children
Mandate a Planning and Monitoring
Maharashtra has specific pro-poor and pro- Unit within MoTA to allow generating
tribal strategies. For example, filling supply and utilizing tribal disaggregated data for
and payment backlogs at AWCs in tribal planning, monitoring and liaising with
areas, with special drives to: (i) fill vacant other departments at the state and
posts at all levels across the Department ITDA levels.
for Women and Child Development and
Department for Health and Family Welfare; 2. Include nutrition as an agenda item in
(ii) relax recruitment norms and improve project level inter-ministerial meetings
training of functionaries; (iii) encourage (immediate to medium term)
regular government visits to remote
and unvisited villages; (iv) organize pre- Include nutrition as an agenda point in
monsoon camps for health checks and project level inter-ministerial coordination
nutrition counselling by all doctors; committee meetings convened by MoTA.

Synthesis of deliberations and recommendations 27


3. Replicate good practices (medium to 6. Implement dashboard monitoring
long term) (immediate to medium term)

Explore replication of the Andhra Pradesh Implement periodic block-centric dashboard


administrative model in tribal areas, and monitoring of a few actionable indicators.
with ITDA as single line administration and
responsible for service delivery in tribal 7. Incorporate targets in Result
areas. It would also be useful to establish a Framework Document (immediate to
tribal programme management unit within medium term)
key line departments (as in Andhra Pradesh
under NRHM) with a designated tribal Incorporate targets in tribal areas in
programme officer and tribal PIP. the Result Framework Document for
departments of Women and Child
4. Expand provisions under TSP to Development, Health, Drinking Water and
include nutrition items (medium to Sanitation, and Rural Development.
long term)
8. Ensure transparency of allocation
Expand TSP to: (i) be needs-based; and use of TSP resources (medium to
(ii) include gender and nutrition long term)
interventions; (iii) encourage budgetary
provisions for new infrastructure and The allocation and utilization of resources
maintenance, targeting institutions under TSP as well as other government
providing essential social services, programmes should be open to public
AWCs, crèches and NRCs; and (iv) scrutiny through social and IT-based
provide fellowships of one to two years tracking mechanisms.
to young contractual professionals,
supported by grants, towards enhancing 9. Advocate for food fortification
ITDAs on special projects. (medium to long term)

Planning Departments/PMO Advocate for food fortification with MoHFW


and civil supplies to begin with in tribal
5. Map districts with high burden of areas, given the high burden of multiple
stunted children (immediate term) micronutrient deficiencies in these areas.

Map districts contributing to the burden 10. Establish Nutrition Coordination Cell
of stunted children in terms of numbers; in PMO (medium to long term)
identify which of the 10 nutrition
interventions to reduce the burden to be Establish a Nutrition Coordination Cell at
implemented within each district and by PMO level with special focus on tribal
block; and accordingly develop context peoples to accelerate coordinated action in
responsive plans and provide results- all the key sectors.
based incentives.

28 National Conclave: Nourishing India’s Tribal Children


Session highlights

Parallel session 6: Role of academic institutes and NGOs in improving


nutrition services in tribal areas

Challenges 3. The number and geographical coverage


of NGOs and faith-based organizations
The following challenges constraining working in tribal areas are limited, which
improvement of partnerships to address reduces further in civil strife affected
tribal nutrition problems were highlighted areas. Most organizations have focused
during the parallel session: on mobilization at community and
household level and linkage with service
1. Gaps in research on tribal data include: providers has not been significant, while
(i) tribal research and ICMR regional tribal relatively very few work with ITDAs on
centres remain untapped for periodic TSP to support such planning.
evaluation and dashboard monitoring
of basic schemes; (ii) ICMR National 4. Acquisition of forestland for development
Nutrition Monitoring Bureau reports by the government is constrained by
on tribal population currently provide problems of inadequate compensation
information only on select nutrition and poor resettlement and livelihood
indicators and is limited to select states; arrangements, leading to increasing
(iii) the sample size in large-scale surveys indebtedness and poverty. The inherent
representing tribal peoples is often not shyness and lack of collective voice
large enough, thereby increasing the of tribal peoples to demand their
margin of error when disaggregating entitlement(s) mean that they never
data for tribal children; and (iv) there is no reach a critical mass to create positive
independent report on the nutritive value pressure on the government to change
of forest foods, which are rich the nature of response.
in nutrients.
5. Issues of undernutrition among tribal
2. There are only a few alliances and children grab headlines only when there
organizations working to raise issues are reported deaths of hunger.
related to nutrition of tribal peoples.
Forums in which scheduled castes Promising practices
and scheduled tribes are represented
together inherently favour scheduled The following promising practices were
castes because of their stronger presented and discussed During this
collective voice and larger numbers. parallel sessions:
Federations of organizations working for
tribals have not been as strong, unlike 1. Use of participatory learning cycles in
federations for other social groups. Most women’s groups to reduce neonatal
civil society organizations working in mortality and undernutrition
tribal areas are led by non-tribal leaders
(though many invest in tribal youth This promising practice involves running
leadership), reiterating the lack of tribal crèches with links to nutrition, national
leadership and collective voice. resources and agriculture. It has paved

Synthesis of deliberations and recommendations 29


the way to improve complementary to expecting/lactating mother and children,
feeding with links to livelihood, agriculture covering all aspects of maternal and child
and nutrition. It is supported by Ekjut in healthcare. Riddhi Foundation is working
collaboration with consortium partners in collaboration with the National Health
across Chhattisgarh, Jharkhand, Madhya Mission, Palakkad, Kerala, to develop the
Pradesh and Odisha. Jatak application for the Attappady NRC.

2. Women’s groups engaged to 5. Media sensitized on critical issues


run crèches including nutrition

Surguja Suposhan Abhiyaan in Chhattisgarh NGO Jan Samvad working in Madhya


with support of frontliners (mitanin, Pradesh has been engaging with media to
community health worker) and State sensitize them on writing about nutrition
Health and Family Welfare (SHRC) share issues affecting tribal populations.
responsibilities wherein communities manage
crèches and SHRC plays an important role in Recommendations
training, research and evaluation.
The group work discussions held under this
3. NGO workers work with health parallel session generated the following
frontliners recommendations, which have been classified
into immediate-, medium-, and long-term
SEWA Rural, an NGO in Gujarat, is linking actions according to suggestions made by the
its NGO workers (1:8 villages) and the ANM/ panellists in the concluding session:
field supervisor (1:15 villages) to support
various innovations. The innovations used Academia/research institutes/
in this model include: sickle cell anaemia development agencies
programme; special camps for underweight
children; child-wise output and outcome 1. Demonstrate feasibility of
monitoring; and innovative mobile phone multi-sectoral nutrition actions
technology for community health operation – (immediate term)
work plan on mobile phone, tasks completed
uploaded immediately, videos for counselling, Tap on Bharat Rural Livelihood Missions,
and tracking children. This PPP model works Council for Advancement of People’s
together with the Government of Gujarat. Action and Rural Technology (CAPART),
Vanbandhu Kalyan Yojana, Aajeevika
4. Mobile-based application to capture platforms and Sansad villages to
‘real time’ data of each child demonstrate feasibility of multi-sectoral
nutrition actions to accelerate reduction of
NGO Riddhi Foundation is developing a undernutrition among tribal children.
mobile-based application with a voice
feature to capture ‘real time’ data of each 2. Enable dashboard monitoring of
child, supporting a screening system and actionable indicators (immediate to
sms feedback mechanism. Two mobile medium term)
telephony applications – one for the child
(Jatak) and one for mothers (Janani) – is Engage IITs and Indian Institutes of
being developed, which can capture, Management and related institutes to
transmit and process real time data related develop dashboard monitoring, using GIS, of

30 National Conclave: Nourishing India’s Tribal Children


Session highlights

a few actionable indicators or from centile Malnutrition to advocate for tribal children
sites for monitoring outputs and outcomes on the following issues: (i) raise issues of
against inputs (e.g., tracking use of budgets tribal undernutrition in parliament; (ii) meet
for results). with concerned authorities and ministers in-
charge of provision of basic public services
3. Generate reliable data of extent and in tribal areas; (iii) collective field visits with
nature of undernutrition (medium to concerned officers in tribal villages that
long term) have never been visited; (iv) concentrate
on demonstrating change in respective
Generate credible data about the extent constituencies; and (v) advocate for special
and nature of undernutrition among tribal nutrition gram sabha and social audit of
children. Expand the scope of ICMR to nutrition programmes in tribal areas.
conduct periodic universal tribal nutrition
surveys, at least once in three years. 2. Share knowledge on tribal nutrition
(medium to long term)
4. Harmonize key indicators across
national surveys (medium to Encourage the Supreme Court office for
long term) right to food to examine pertinent issues,
publish and highlight special reports, and
Build parity and harmonize key indicators share findings with line ministries on a
across databases of national surveys such periodic basis.
as the Census and National Family Health
Survey. Extend the NSSO tribal nutrition Media
surveys conducted by ICMR across the
country to improve comparability over time 1. Highlight experiences and
and geographic areas. show disparities (immediate to
medium term)
5. Support food composition analysis of
tribal food (medium to long term) Provide media experiences from the field
and highlight disaggregated data that show
Encourage nutrition departments of disparities as well as cross linkages of
home science colleges to support food interventions.
composition analysis of tribal food (including
uncultivated forest foods). Curriculum 2. Showcase media champions
on tribal nutrition should be layered and (immediate to medium term)
enhanced across graduate and postgraduate
nutrition curriculum. Showcase media champions from the field
at district and sub-district level, who work
Alliances tirelessly to highlight core tribal concerns in
various print and electronic media channels.
1. Advocate for special strategies for
reducing undernutrition among tribal 3. Create media group to highlight tribal
children in the nine states (immediate nutrition issues (medium to long term)
to medium term)
Create a digitally connected group of
Tap into the Parliamentarian Group for like-minded media that are interested in
Children and Citizens’ Alliance against highlighting issues on tribal nutrition.

Synthesis of deliberations and recommendations 31


©UNICEF India/Kesab Chandra

Special community conclave


Voices of frontliners
There was a separate session with tribal communities to understand their perspectives
on the required actions to reduce undernutrition among tribal children. The following
recommendations were made by them:

Prioritize villages that have not received attention


Prioritize the visits of government officials to the villages where they
have not been as yet.

Stop use of pesticides in farming


Pesticide-based farming should cease as it is harmful to children who
accompany their mothers working in the fields. Traditional crops and
cropping methods should instead be promoted.

32 National Conclave: Nourishing India’s Tribal Children


Session highlights

Share information on growth of tribal children


Anganwadi workers should share data from recorded growth
monitoring with the community to enable it to understand the
progress made by the children.

Prevent child marriage and early pregnancy


One of the key reasons for undernutrition in children is early
pregnancy. Efforts to prevent child marriage and early pregnancy
should be accelerated.

Encourage public servants to work in tribal areas


The duration of tribal postings should be fixed and be on a
rotational basis so that public servants are encouraged to work and
stay in tribal areas.

©UNICEF India/Kesab Chandra


Recognize and promote forest foods
Forests as a food producing habitat should be recognized and
forest foods promoted.

Include tribal peoples in planning


Most importantly, include tribal peoples in development of plans.
Often, plans and schemes do not consider their needs.

Synthesis of deliberations and recommendations 33


©UNICEF India/Kesab Chandra

Plenary 3
Way forward

Consolidated recommendations from all six parallel sessions and special session on voices of
frontliners were presented during the concluding session. After the presentations, the chairs
of this session emphasized the following points:

1. Tap on Bharat Rural Livelihood Missions, community voice, they are not
CAPART, Vanbandhu Kalyan Yojana, substitutes for the government.
Aajeevika platforms and Sansad villages to
demonstrate multi-sectoral nutrition action. 3. Hold state conclaves in each of the
nine states to take recommendations
2. Recognize that while SHGs are good forward.
service delivery agents and represent

34 National Conclave: Nourishing India’s Tribal Children


Session highlights

Post-conclave ripples

©UNICEF India/Omesh Matta


Shortly after the conclave, the following actions were carried out:

1. The National Institute of Rural conclave, to tackle undernutrition in tribal


Development and Panchayati Raj and children through state TSP funds and a
UNICEF signed a Memorandum of special plan for tribal children.
Understanding on 17 June, 2015, to
create and institutionalize a curriculum for 4. Jharkhand has announced the formation
multi-sector officials to improve access to of a nutrition mission with special focus
nutrition services in rural and tribal areas. on tribal pockets.

2. The Parliamentarian Group for Children 5. Chhattisgarh has scheduled a high level
organized its first meeting on 21 July, state conclave to take the deliberations
2015, with cross-party members to raise of the national conclave forward through
awareness of the issues and actions to two new schemes under the National
improve the nutrition of tribal children. Rural Livelihoods Mission.

3. Madhya Pradesh has announced a 6. Maharashtra has announced the extension


targeted approach, based on several of its nutrition mission (part 3) with a
recommendations from the national focus on tribal and poor urban areas.

Synthesis of deliberations and recommendations 35


Annex
Conclave agenda
Conclave: Nourishing India’s Tribal Children
Voices of frontliners, promising practices and policy implications
15-16 January, 2015: Mayfair Convention, Bhubaneswar

DAY I: 15 January, 2015 (Thursday)


Time Programme Speaker
Plenary 1: Inaugural ceremony by State Government of Odisha [Master of Ceremony:
Ms. Pamela Philipose]
0930-1020 Registration and seating before arrival of Hon’ble Ministers, Odisha and
Hon’ble Member of Parliament
1020-1025 Welcome Yumi Bae, Chief, Field Office, UNICEF
Odisha
1025-1030 Keynote address Shri Surendra Kumar, IAS, Commissioner
cum Secretary, Scheduled Tribes and
Scheduled Castes (ST&SC) Development
Department, Government of Odisha
1030-1040 Lighting of lamp Dignitaries on the Dais
1040-1110 Speech Mr. Louis-Georges Arsenault, UNICEF
Commitment for tribal children India Representative
Shri Baijayanta (Jay) Panda, Hon’ble
Member of Parliament, Citizens’ Alliance
Against Malnutrition
Shri Sudam Marandi, Hon'ble Minister of
State (Tribal Welfare), Odisha
Shri Lal Bihari Himirika, Hon’ble Minister,
ST&SC Development Department, Odisha
1110-1115 Vote of thanks Shri R. Raghu Prasad, IFS, Director,
ST and Additional Secretary ST&SC
Development Department, Odisha
1115-1130 Inauguration of stalls of NGOs Shri Lal Bihari Himirika, Hon’ble Minister,
and forest foods corridor ST&SC Development Department, Odisha
1130-1145 TEA-BREAK
Plenary 2: Context setting [Master of Ceremony: Ms. Pamela Philipose]
1145-1200 MoTA’s food and nutrition Shri Gopal Sindhwani, Ministry of Tribal
security efforts for tribal Affairs (MoTA), Government of India (GoI)
children
Importance of a multi-sectoral Dr. Saba Mebrahtu, UNICEF India
approach to addressing
undernutrition in tribal
communities

36 National Conclave: Nourishing India’s Tribal Children


Session highlights

1200-1215 Stocktaking of efforts to Dr. Manoj Jhalani, Ministry of Health and


improve nutrition and health Family Welfare (MoHFW), GoI
services in tribal areas
1215- 1230 Stocktaking of efforts of Shri Gulshan Lal, Ministry of Women and
Ministry of Women and Child Child Development (MoWCD), GoI
Development to improve ICDS
services in tribal areas
1230- 1245 Ministry of Drinking Water Smt. Urvashi Prasad, Ministry of Drinking
and Sanitation: Provisions and Water and Sanitation (MDWS)
innovations for tribal areas
1245- 1300 Linking poverty alleviation and Ms. Nita Kejrewal, Director, National Rural
nutrition: Aajeevika experience Livelihood Promotion Society (NRLPS),
Ministry of Rural Development (MoRD),
Government of India
1300- 1325 Improving nutrition coordination Dr. S. B. Agnihotri, IAS, Secretary,
for tribal children Coordination and PG, Cabinet Secretariat,
GoI
1325- 1330 Announcement for parallel Ms. Pamela Philipose, Master of
sessions Ceremony
1330- 1430 LUNCH
Parallel sessions
Stirring multi-sectoral action for nourishing tribal children in Central India:
what needs to be done and how?
[experiential evidence, field realities and practical solutions]
1430-1800 PARALLEL SESSION 1 PARALLEL SESSION 2 PARALLEL SESSION 3
Improving household Improving Integrated Improving tribal
food and livelihood Child Development health outreach and
security Services (ICDS) in referral services
tribal areas
1430-1530 Panel Discussion Panel Discussion Panel Discussion
GoI representation: GoI representation: GoI representation:
Ms. Nita Kejrewal, Shri Gulshan Lal, Dr. Sila Deb, Deputy
Director, NRLPS, Director, MoWCD, GoI Commissioner (Child
MoRD, GoI Health) and Nodal
Officer Nutrition,
MoHFW, GoI
Technical lead: Dr. Technical lead: Dr. N. Technical lead: Ms.
Ajay Parida, Executive C. Saxena, Ex. Supreme Arti Ahuja, IAS, Principal
Director, M.S. Court Commissioner to Secretary, DHFW, GoO
Swaminathan Research Right to Food
Foundation (MSSRF)

Synthesis of deliberations and recommendations 37


Presenters: Presenters: Presenters:
1.  Ms. Amrapali Kata, 1.  Shri Saswat Mishra, 1.  Dr. Pavitra Mohan,
IAS, Telangana (One IAS, Secretary, Rajasthan (Outreach
full meal scheme) DWCD, GoO services)
2.  Dr. Rajeshree Joshi, (Decentralized 2.  Dr. John Oomen,
Dhruva Bharatiya feeding) Odisha (Referral
Agro Industries 2.  Shri Sameer services)
Foundation (BAIF), Garg, State Health 3.  Dr. Neeru Singh,
Gujarat (Food Resource Centre Indian Council of
insecurity and (SHRC), Chhattisgarh Medical Research
initiatives) (Mitanins) (ICMR), Jabalpur
3.  Shri Saroj Mahapatra, 3.  Shri Yogesh Jain, (VBD)
Professional (Public funded 4.  Dr. Suhas Kadam,
Assistance for crèches – issues to Jan Swasthya
Development consider) Sahyog (JSS),
Action (PRADAN), 4.  Ms. Lakshmi Chhattisgarh
Chhattisgarh Durga Chava, (Improving tribal
(Nutrition-agriculture Director, Society for health, outreach
SRI consortium) Elimination of Rural and referral service/
4.  Dr. Manohar Agnani, Poverty (SERP), JSS experience)
IAS, Commissioner, Andhra Pradesh 5. Swami
Food and Civil (Nutrition and Yogishwarananda,
Supplies Madhya Day Care Centers) Ramakrishna Mission
Pradesh (NFS (NDCCs) (RKM), Chhattisgarh
implementation in (Conflict and ICDS)
Madhya Pradesh:
Improvements in
TPDS)
1530-1600 Comments from Chair Comments from Chair Comments from Chair
and Questions/Answers and Questions/Answers and Questions/Answers
1600-1630 TEA-BREAK
1630-1800 Group work & Group work & Group work &
Recommendations - Recommendations - Recommendations -
Moderator: Ms. Biraj Moderator: Ms. Neerja Moderator: Shri Pankaj
Swain, Researcher Choudhury, Journalist Pachauri, Journalist
2000-2200 Traditional dance and dinner
Mayfair Lagoon

38 National Conclave: Nourishing India’s Tribal Children


Session highlights

DAY II: 16 January, 2015 (Friday)


Time Programme
0930-1000 Summary of previous day and schematics for the Day II [Master of
Ceremony: Ms. Pamela Philipose]
1000-1400 Parallel sessions
Stirring multi-sectoral action for nourishing tribal children in Central India:
what needs to be done and how?
[experiential evidence, field realities and practical solutions]
1000-1400 PARALLEL SESSION 4 PARALLEL SESSION 5 PARALLEL SESSION 6
Improving drinking Tribal budgets, Role of academic
water and sanitation governance and institutes and NGOs
services/commodities in coordination for nutrition in improving nutrition
tribal areas services in tribal areas
1000-1100 Panel Discussion Panel Discussion Panel Discussion
Chair: Shri M.K. Chair: Dr. S. B. Chair: Shri
Rout, IAS, Secretary, Agnihotri, IAS, Shubhranshu
DoRD, Government of Secretary, Coordination Choudhary, Central
Chhattisgarh and PG, Cabinet Gondwani Net Swara
Secretariat, GoI (CGNet Swara), Central
Gondwana (CG)
Technical lead: Ms. Technical lead:
Technical lead: Dr. Sona Mitra, Senior Shri Amitabh Behar,
Kamal Kar, Director, Research Officer, Executive Director,
Community-led Total Centre for Budget National Foundation of
Sanitation (CLTS) and Governance India
Accountability (CBGA)

Presenters: Presenters:
Presenters: 1.  Shri China Veera Shri R. Prasana, IAS,
1.  Shri Arvind Ojha, Bhadrudu, Andhra Chhattisgarh (Fulwari)
Rajasthan (Water Pradesh: Tribal Sub Dr. Dhiren Modi,
scarcity) Plan (TSP) Act Gujarat, Self-employed
2.  Ms. Deepshikha 2.  Ms. Vandana Women’s Association
Kumari, Jharkhand Krishna, IAS, Govt. (Sewa - Rural
(Lack of sanitation of Maharashtra experience)
commodities) (Nutrition Mission) Shri K. K. Pal and State
3.  Dr. Kamal 3.  Shri Banchhanedhi government Kerala (Use
Kar, Director, Pani, IAS, Govt. of of GIS in tribal areas)
Community-led Gujarat (Planning)
Total Sanitation
(CLTS)

Synthesis of deliberations and recommendations 39


4.  Shri Siddharth V. 4.  Prof. K. Sujatha, Dr. Prasanta Tripathy
Patel, Gujarat, (Water (Ensuring basic (Ekjut’s experience)
and Sanitation civic services for
Management adolescent girls in
Organisation ashramshalas)
(WASMO)) 5.  Ms. Chandrika Singh,
5.  Dr. Alok Pandey, Centre for Budget
Participatory and Governance
Research in Accountability
Asia (PRIA) (CBGA)
(Decentralized water (Tribal Sub Plan
and sanitation) (TSP) Budgeting for
tribal nutrition)
1100-1130 Comments from Chair Comments from Chair Comments from Chair
and Questions/Answers and Questions/Answers and Questions/Answers
1130-1200 TEA-BREAK
1200-1400 Group work & Group work & Group work &
Recommendations - Recommendations - Recommendations -
Moderator: Ms. Neerja Moderator: Shri Rahul Moderator: Shri Amitabh
Chowdhury Dev Behar
1000-1400 Special community conclave: Voices from frontliners
1400-1500 LUNCH
Plenary 3: Way Forward & Valedictory [Master of ceremony: Ms. Pamela Philipose]
1500-1600 Prayer
Recommendations of all parallel sessions:
On the Dias:
l  Dr. S. B. Agnihotri, IAS, Secretary, Coordination and PG, Cabinet
Secretariat, GoI
l Shri S. M. Vijayanand, IAS, Special Secretary, Ministry of Rural
Development, GoI
l  Shri Suresh Vashisht, IAS, Secretary to Minister, Ministry of Tribal Affairs,
GoI
Presenters: Chairs of panel discussions

40 National Conclave: Nourishing India’s Tribal Children


There are 6.2 million tribal children aged under five
in India who are stunted, 4.7 million of whom live
in just nine states, according to the National Family
Health Survey 2005-2006. A two-day national conclave,
attended by 297 delegates, to draw attention to stunting
among tribal children across the nine states was held
on 15-16 January, 2015, in Bhubaneswar, Odisha,
India. This publication synthesizes the deliberations
and recommendations on the way forward to prevent
undernutrition in India’s tribal children.

This publication has been written and


produced by UNICEF India Country Office.

United Nations Children´s Fund


India Country Office
UNICEF House
73, Lodi Estate
New Delhi 110003
Telephone: +91 11 24690401
www.unicef.in

Cover photo: ©UNICEF India/Sandesh Bandare

42 National Conclave: Nourishing India’s Tribal Children